fluenza. DoD-GEIS provided funding, programmatic support, and professional guidance to the Air Force in administering this new program, which then became two-pronged (AFIOH, 2006b, DoD, 2006). One prong was surveillance among U.S. military personnel and DoD medical beneficiaries; the second was surveillance in civilian populations in areas of the world where DoD units were located and which were suited to surveillance and to the providing of support to host country populations and allied countries. AFIOH also contributes to the Vaccines and Related Biological Products Advisory Committee (VRBPAC) of the U.S. Food and Drug Administration (FDA) and the Armed Forces Epidemiological Board now known as the Defense Health Board.

A site visit team of the Institute of Medicine (IOM) Committee for the Assessment of DoD-GEIS Influenza Surveillance and Response Programs visited AFIOH on March 28-29, 2007.1 A list of the people met and interviewed and the itinerary followed can be found at the end of this chapter.


While the majority of the avian influenza/pandemic influenza (AI/PI) supplemental funding has been allocated to personnel costs, it does not appear that personnel dedicated to assure quality were added as each section was expanded. The AFIOH laboratory has a rigorous quality-assurance program associated with its College of American Pathologists (CAP) and Clinical Laboratory Improvement Program (CLIP) accreditations. However, the lack of technical expertise in particular areas has limited the effectiveness and sustainability of AFIOH’s expanded AI/PI surveillance and detection program.

AFIOH has spent a significant portion of the AI/PI supplemental funds on one-time-only expenditures, and it expects that the increase in capacity, particularly in molecular biology, data management, and added surveillance sites, can be maintained in the future with an annual funding level of approximately equal to one-third of the $4.1 million AFIOH received.

The AFIOH program is expecting a move to Wright-Patterson Air Force Base in Dayton, Ohio, by 2011, and personnel involved in the influenza program are aware that this move will be a challenge for their program. The issues that they expect include retaining personnel in San Antonio until the site closes, side-by-side operations for some period of time, the potential need to rebuild the program in Dayton, and the reluctance to make neces-


Prior to the committee’s visit to AFIOH, the laboratory staff provided the committee with detailed background information on AFIOH and the pandemic/avian influenza activities it was supporting. These materials were used in the writing of this chapter and are available from the IOM in the Public Access File.

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